Digital Connected Care: Convergence & Evolution of Workflows

The Digital Connected Care article series elevates the conversation from tech talk to the practical application of remote patient monitoring in clinician designed workflows with evidence of improved outcomes without increasing staff burden.

Clinicians must guide system developers on how to support specific clinical applications with evidence of improved outcomes for the patient and care team.

The Public Health Informatics Institute recently published a report listing a host of challenges regarding moving patient generated health data in general, and its utility in Self-Measured Blood Pressure (SMBP) Monitoring in particular.[1] The report highlights that there remains confusion in the industry on which standards to apply for the effective movement of data between blood pressure devices and the clinician. Recommendations to address these challenges include developing an implementation framework to support the movement of SMBP data.

This framework must start with a clinician designed workflow that specifically addresses the flow of patient generated health data (PGHD) that challenges the clinician who is trained to manage chronic disease primarily from information gathered at the time of an office visit. This flow often contains a large set of multiple data points, and requires analytics to make the data usable in the clinical setting in order to benefit the patient and the clinical team. Unlike the electronic health record that primarily stores encounter (transactional data), the clinical team with the effective application of PGHD technology uses the resulting analytics to manage the patient through shared decision making and to generate population metrics.

A common foundation

Earlier blogs in this series, “Workflows by the Clinician, for the Clinician” and “Self-Measured Blood Pressure to Manage Hypertension”, proposed “proving grounds” to demonstrate the effective and efficient integration of PGHD into clinical workflows. While the design of workflows must be specific to achieve the intended outcomes, the underlying health IT infrastructure that enables this integration is common across many workflows. This suggests that a foundation can be established upon which many existing and future workflows can be built, enabling the effortless exchange of PGHD.

Speak each other’s language

Providers often view patients or diseases as discrete encounters or challenges which require uniquely tailored approaches and tools. Software engineers on the other hand usually see solutions to problems as one or another assembly of reusable components. Software that works for hypertension management may also work for diabetes management, plus or minus one or two unique objects. A challenge that can bridge the gap between clinicians and software designers is to envision clinicians’ unique disease workflows in terms of the many reusable objects rather than the few unique values. If clinicians have a basic understanding of software design and the software engineer has a basic understanding of the relationship between analytics and disease management, progress should be easier.

Tangible opportunity

Business cases identify and quantify the opportunity of these more evolved workflows in terms of meeting a health ministry’s social obligations and a health organization’s return on investment. More specifically, an important element of a business case is to articulate and promote the value proposition that define specific features, benefits and experiences while addressing customers’ wants, needs and fears that are not currently being met in the marketplace.

A clear link shows value

An effective use case builds off the business case, starting with specific features and experiences that address the wants and needs of the targeted user. This provides an invaluable link to define the roles of the key players and the products or services that form the foundation of the use case. This link maintains a clearly defined path that ensures continued focus on the value proposition for the target audience as development moves from use case, to technical requirements, to standards and finally implementation.

As a case in point, the Workflows by the Clinician for the Clinician blog illustrated that the automatic linking of PGHD and PROMs is not the value proposition, but a feature essential to providing the “raw” health data that feeds the analytics and knowledge base that is of value to the clinician. This same linking of PGHD into the workflow provides the patient and care team with the value that comes with employing self-monitored blood pressure to manage hypertension.

Market driven technology development

HIMSS Accelerate Health is working with clinicians and system integrators to identify specific workflows to achieve intended outcomes, translate these workflows into use cases, determine the technical requirements that must be met by open standards, work with SDOs to advance the relevant standards, sponsors industry organizations such as IHE to define a uniform implementation of these standards essential to achieve interoperability, creates commercial ready software that enables the rapid implementation of these profiles, and provides test environments to demonstrate compliance to the standards and interoperability with the health information ecosystem.

You are invited to participate in this effort by joining the HIMSS Innovation Organization, Personal Connected Health Alliance.

[1] Public Health Informatics Institute Self-Measured Blood Pressure Monitoring

Previous Blogs in This Series:

1. The Innovation Journey 
2. Workflows by the Clinician, for the Clinician 
3. SMBP to Manage Hypertension 
4. Surge Care for the 21^st Century 
5. Translating Data into Knowledge 
6. Inclusive Access & Control